Provider Demographics
NPI:1841649613
Name:RADFORD, TEAL HANNAH (MA)
Entity type:Individual
Prefix:
First Name:TEAL
Middle Name:HANNAH
Last Name:RADFORD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 STETSON CREEK DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-3039
Mailing Address - Country:US
Mailing Address - Phone:763-232-0504
Mailing Address - Fax:
Practice Address - Street 1:2130 STETSON CREEK DR UNIT D
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3039
Practice Address - Country:US
Practice Address - Phone:763-232-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-12
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-5976235Z00000X
COSLP.0005747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist